Individuals in the denominator who filled at least three prescriptions (in different months) for ACEI/ARB medications during the measurement year
Diabetic patients (identified by medication or lab data), aged 18 to 74, with evidence of kidney impairment in the year prior to the measurement year, excluding those who meet at least one of the following criteria during that year: 1. Receiving dialysis 2. Having at least one GFR or eGFR result with the most recent value below 30 mL/min/1.73 m². 3. Having no GFR/eGFR value but at least one creatinine test with the most recent result above 3.5 mg/dL or 310 µmol/L 4. Having at least one urine protein or albumin test with all results within normal limits (microalbumin ≤ 30 mg/day) or (albumin-to-creatinine ratio ≤ 30 mg/g) or (total urine protein ≤ 150 mg/day) or (protein-to-creatinine ratio ≤ 200 mg/g or ≤ 0.2 mg/mg).
20%-40% of diabetes patients will develop kidney complications (1). Diabetes is the most common cause of kidney damage, progressing to end-stage renal failure, a condition that requires dialysis or a kidney transplant. The most essential laboratory test for early detection of kidney damage in diabetic patients is monitoring the levels of albumin excreted in the urine. When kidney function begins to deteriorate, urinary albumin levels gradually increase. Albumin excretion of over 300 mg/day is a marker of kidney disease progression and the development of end-stage renal failure. In addition, albuminuria indicates a patient is at high risk for cardiovascular disease. Tests to detect albuminuria (increased excretion of the protein albumin in the urine) should be performed at least once a year. However, some patients may develop diabetic kidney damage characterized by a decline in GFR (Glomerular Filtration Rate) without elevated protein excretion. In such cases, regular monitoring of GFR is essential for detecting kidney damage. Additionally, tracking GFR is important for assessing the severity of renal failure, identifying and treating patients at risk for complications of kidney failure (such as electrolyte imbalances or bone metabolism disorders), and referring patients with advanced kidney failure for nephrology evaluation and dialysis preparation. Therefore, annual monitoring of renal function is recommended for all diabetic patients, with more frequent assessments for those experiencing a decline in kidney function. This monitoring is critical due to the availability of effective therapeutic interventions that can slow the progression of kidney damage once detected. These include angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), particularly in diabetic patients presenting with hypertension and proteinuria, as well as sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. Optimal management of blood pressure and glycemic control also plays a pivotal role in mitigating renal disease progression (1)(2).
Note: eGFR can be calculated based on blood creatinine levels using various formulas. In this program, eGFR is not calculated independently but taken as reported from the health fund databases.
1. American Diabetes Association. Standards of Medical Care in Diabetes – 2017. Am Diabetes Assoc. 2017;40.
2.Davies MJ, D’Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the european association for the study of diabetes (EASD). Diabetes Care. 2018;41(12):2669–701.
